The Value of a Statistical Life-Year in Sub-Saharan Africa: Evidence From a Large Population-Based Survey in Tanzania.

The value of a statistical life-year (VSLY) is the central number for the economic allocation of health resources. Nevertheless, empirical data on VSLY are lacking for most low- and middle- income countries. In the absence of empirically established VSLY, researchers typically use an arbitrary 3-times multiple of per-capita gross domestic product or per-capita income per life-year saved to establish cost-effectiveness. In this study, we establish an empirical VSLY for the first time for a community in sub-Saharan Africa. To empirically establish VSLY, we randomly selected 4000 individuals in the Ukonga community of Tanzania and employed a contingent valuation survey to measure VSLY. Using the contingent valuation methodology, we elicited willingness to pay for a 2% mortality risk reduction and had individuals convert this into an annualized payment to be paid each year over their expected remaining life. We compared our elicited value to per-capita income and found that mean VSLY is $9340 (95% CI $6206-$12 373). The mean annual income in our sample was $2069, resulting in a VSLY that is equivalent to 4.5 times per-capita income. Our results provide empirical evidence to support moving away from using the World Health Organization cost-effectiveness thresholds in practice because they will likely result in inefficient underinvestment in cost-effective interventions, even in relatively poor samples. • We establish the first value of a statistical life-year estimate through stated preference elicitation for a community in sub-Saharan Africa. • Elicited value of life in a poorer-than-average population in Tanzania significantly exceeds the World Health Organization's 3-times-per-capita gross domestic product threshold for cost-effectiveness. • According to our estimates, policies based on the standard cost-effectiveness thresholds of 1- and 3-times-per-capita income will lead to health investments that are substantially below the social optimum. [ABSTRACT FROM AUTHOR]